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Orthopedic Coding Alert

Reader Questions:

Don't Charge Medicare for These Bone Grafts

Published on Sat Aug 27, 2005

Question: Do insurers bundle bone graft procedures 20930 and 20936 into arthrodesis procedures 22612 and 22630? I cannot find these edits in the NCCI, but my Medicare payer won't reimburse us for either 20930 or 20936 with 22612 and 22630.


California Subscriber


Answer: You are correct that the National Correct Coding Initiative (NCCI) does not bundle either 20930 (Allograft for spine surgery only; morselized) or 20936 (Autograft for spine surgery only [including harvesting the graft]; local [e.g., ribs, spinous process or laminar fragments] obtained from same incision) into either of these codes:
 

  • 22612 - Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or without lateral transverse technique)
     
  • 22630 - Arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single
    interspace; lumbar    .

    You are having difficult getting paid because Medicare designates graft procedures 20930 and 20936 as status "B" codes, so CMS policy dictates that Medicare payers always bundle these codes into payment for other services.

    In other words, Medicare does not preclude you from reporting 20930 or 20936 with 22612 or 22630, but it will not pay you extra for the grafting procedures.

    In fact, because of the codes' status "B" designation, Medicare payers will never pay you for these services, regardless of the primary procedure code(s) you claim.

    In addition, you cannot charge the patient for the disallowed amounts because Medicare has "already paid" you for these services as part of the payment for the primary procedure.

    Private payers may reimburse 20930 and 20936, so don't stop reporting these procedures. Your best strategy with Medicare is simply to write off the codes as "disallowed" when Medicare does not pay.

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